Doctors fail to wash hands before treating patients, study finds

Amy Corderoy

Doctors in Australia's biggest hospitals are routinely failing to wash their hands before touching patients, new figures show.

A of the "hand hygiene" rates in some of Australia’s biggest hospitals has found patients could be routinely exposed to potentially deadly infectious bugs by doctors who are not following proper hygiene procedures.

While nurses and other staff have shown drastic improvements in hand hygiene, doctors are still lagging behind when it comes to the first, crucial moment of contact with a patient.

A leading infectious diseases expert has called on Australia’s hand hygiene program to be overhauled and next week NSW Health Minister Jillian Skinner will launch a program to specifically target doctors who are not following the rules.

Advertisement

Mary-Louise McLaws, a professor of epidemiology in healthcare infection and infectious diseases control at the University of NSW, said her research provided an “uncomfortable message”.

Less than a third of the large teaching hospitals met national targets that state doctors should remember to clean their hands before touching a patient at least 70 per cent of the time, according to Professor McLaws' paper, published by the Medical Journal Of Australia.

In NSW the best performing hospital was Tamworth Base, with 87 per cent compliance. The worst was The Tweed, with only 63 per cent.

Professor McLaws said real rates could be even lower, as audits involved physical supervision.

“It is quite remarkable given that the healthcare worker can see the auditor [that] they still aren’t getting their hand hygiene rates up really high,” she said. “I think part of the problem is this is a result of our focus on ‘Key Performance Indicators’ instead of assisting the health workers with behaviour change.”

Hospitals run their own hand hygiene audits and while Hand Hygiene Australia recommends they intervene when staff have not followed correct procedures, many hospitals do not.

“I think it must be the only patient safety measure where they just watch a doctor … [do the wrong thing] and let them carry on,” Professor McLaws said.

She believes everyone who witnesses poor hand hygiene should be trained to discreetly ask the doctor if they ‘have a moment’ and that more attention should be paid to the moment before a doctor touches a patient, rather than all five moments that hand hygience policy currently targets.

“It is transferring it from being a knowledge-based action to being an emotional thing. We have achieved that better with nurses than with doctors,” he said. “The strategies might need to be a bit different, it may be that we say if you don’t use alcohol rub your patients won't think as highly of you.”

But he disagreed with Professor McLaws’ suggestion that the program had failed doctors, as there had been big gains across the nearly 800 hospitals now signed up to it.

“Most of the doctors employed in hospitals are actually not full-time ...so the amount of time we have to teach them about hand hygiene is much less,” he said.

And he said to move away from focusing on all five moments - which include cleaning after a procedure or exposure to bodily fluids - would potentially lead to more environmental contamination. He said nationally there had been a 50 per cent reduction in infections with the golden staph bug as hand hygiene and infection understanding improved.

The program manager of healthcare-acquired infection at the Clinical Excellence Commission, Paul Smollen, said there was "no way to spin" the poor practices among doctors prior to touching a patient.

“There is no positive spin,” he said. The commission was investigating instructing all auditors to intervene if they saw a staff member breaking the rules.

“NSW has for a long period of time been leading the way on this issue,” he said, adding NSW had the best rates of hand hygiene in the country.

Australian Medical Association NSW president Brian Owler said change was being driven by younger doctors and medical students, who knew the value of hand hygiene.

“There is probably some cultural change needed among some of the older doctors, but that really varies from hospital to hospital and doctor to doctor,” he said.

He said there had been some confusion among doctors about the five different "moments" when they were supposed to use hand-cleaning products but “things have been changing”.

The Consumers Health Forum said the figures were simply unacceptable.

“It is deeply disappointing that despite a national campaign on hand hygiene to counter the pain and cost of hospital-acquired infections, a significant number of doctors have remained resistant to following basic good practice on hand hygiene,” chief executive Adam Stankevicius said.